Objective To discuss the surgical selection and effectiveness for patients with recurrent giant cell tumor of bone. Methods Between February 1988 and June 2007, 79 patients with recurrent giant cell tumor of bone were treated. There were 42 males and 37 females, with a mean age of 33.1 years (range, 15-72 years). In primary surgery, 76 patients underwent intralesional curettage, and the other 3 patients underwent resection; the recurrence time was 2-176 months after primary surgery. The locations of tumor were upper extremities in 14 cases and lower extremities in 65 cases. According to Companacci grade, 1 case was at grade I, 33 cases at grade II, and 45 cases at grade III before primary surgery. In secondary operation, 37 patients underwent intralesional curettage and bone grafting combined with adjuvant inactivated, and 42 patients underwent wide resection. Results Bone allograft immune rejection occurred in 2 cases, which led to poor healing; primary healing of incision was obtained in the other patients. The patients were followed up 68 months on average (range, 18-221 months). Recurrence occurred in 12 patients at 6-32 months after operation. The re-recurrence rate was 24.3% (9/37) in cases of intralesional curettage and bone grafting combined with adjuvant inactivated, and they were given the wide resection. The re-recurrence rate was 7.1% (3/42) in cases of wide resection and they were amputated. There was significant difference in the re-recurrence rate between the intralesional curettage and the wide resection (χ2=4.508, P=0.034). No recurrence was observed during 3-year follow-up among re-recurrence patients. Conclusion For benign recurrent giant cell tumor of bone, intralesional curettage and bone grafting combined with adjunctive therapy could get an acceptable effectiveness, however, it has higher local recurrence than wide resection. For large tumor and recurrent malignant giant cell tumor of bone, wide resection is recommended.
Objective To evaluate the influence of combined general and epidural anesthesia on the prognosis of patients undergoing cancer surgery. Methods Such database as PubMed, OVID, EBSCO, The Cochrane Library and CNKI were searched, and other relevant journals and references of the included literature were also hand searched from 1986 to 2011. Two evaluators independently screened the studies in accordance with the inclusion and exclusion criteria, extracted the data and assessed the methodology quality. RevMan 5.0 software was used for meta-analyses. Results Seven studies involving 2 513 patients were included. The results of meta-analyses showed that compared with the single general anesthesia, the combined general and epidural anesthesia had no significant differences in postoperative recurrence and metastasis rate (OR=0.71, 95%CI 0.44 to 1.17, P=0.18). Based on the following four factors i.e. category of cancer, time of follow-up, having preoperative metastais or not, and patients’ age, the sensitivity analysis showed significant differences in the postoperative recurrence and metastasis rate between the two anesthesia methods were found in the group of patients at or above 64 years old and the group with follow-up equal to or less than two years (OR=1.46, 95%CI 1.00 to 2.14, P=0.05; OR=1.55, 95%CI 1.06 to 2.26, P=0.02; respectively). Nevertheless, there was no significant difference in the groups of patients with colorectal cancer or without preoperative metastasis (OR=1.00, 95%CI 0.62-1.61, P=0.99; OR=1.26, 95%CI 0.86 to 1.86, P=0.23; respectively). Conclusion Compared with single general anesthesia, the combined general and epidural anesthesia cannot reduce the recurrence and metastasis rate for cancer patients, and has no marked improvement in prognosis of patients with colorectal cancer or without preoperative metastasis, but it obviously decreases the probability of forward recurrence and metastasis for the patients at or above 64 years old and the patients with follow-up equal to or less than two years.
【摘要】 目的 了解肿瘤复发患者希望水平及其影响因素。 方法 2010年10-12月采用Herth希望量表和自制的一般情况调查表,对302例肿瘤复发患者进行问卷调查,并对相关影响因素进行分析。 结果 肿瘤复发患者希望总体均分为（31.14±5.56）分,7.95%（24例）的患者希望评分为低等水平,74.50%（225例）的患者希望评分为中等水平,17.55%（53例）的患者希望评分为高等水平。肿瘤复发患者希望水平得分的主要影响因素有:婚姻状况、工作状况、医疗费用支付情况、肿瘤类型以及无瘤生存时间。其中,与未婚患者相比,离异患者希望水平较低；与在职患者相比,退休患者希望水平较高；在医疗费用的支付方式上,自费所占的比例越大,患者希望水平越低；与其他肿瘤类型相比,以乳腺癌患者希望水平最低；此外,患者无瘤生存时间越长,其希望水平就越低。 结论 尽管肿瘤复发患者希望水平受多种因素的影响,但多数患者仍对现状和未来充满希望,其希望仍维持在较高水平。【Abstract】 Objective To explore the level of hope and the influential factors of hope in patient with tumor recurrence. Methods A total of 302 patients with tumor recurrence were enrolled. The patients were investigated by Herth Hope Scale and self-designed questionnaire. Results The average level of hope in patients with tumor recurrence was 31.14±5.56; of the total patients，7.95% (24 patients) had low level, 74.50% (225 patients) had media level and 17.55% (53 patients) had high level of hope. Parts of demographic characteristics had significant influences on level of hope and specifically: patient devoiced had lower level of hope than patients married (F=-1.868，Plt;0.05); patients retired had higher level of hope than patients on job (F=2.004，Plt;0.005); patients with greater own proportion of medical expense had lower level of hope than patients with smaller own proportion of medical expense (F=-0.937，Plt;0.05); patients with breast cancer had lower level of hope than patients with other type of cancer (F=-10.824，Plt;0.001); and finally, patients with longer free survival time had lower level of hope than patients with shorter free survival time (F=-1.930，Plt;0.001). Conclusion Parts of demographic characteristics have significant influences on level of hope in patients with tumor recurrence, but most patients still have high level of hope.
Objective To evaluate the outcome of liver transplantation in patients with recurrent liver cancer after resection. Methods Data of 23 patients underwent liver transplantation for recurrent liver cancer from April 2001 to March 2008 were retrospectively collected and analyzed. Results Previous history of liver resection had little negative effect in subsequent liver transplantation in technical aspect. Liver function recovered uneventfully after transplantation in all cases. Alpha fetoprotein (AFP) recovered to normal value in 13 of 17 cases with elevated AFP before transplantation within one month after operation. Five cases (21.74%) had postoperative complications. Nineteen cases (82.61%) were followed up, average follow-up duration were 610 days. There were 5 cases (26.32%) of cancer recurrence and 6 deaths during follow-up, survival rate was 68.42%. Conclusion Liver transplantation is a reasonable treatment for recurrent liver cancer after resection.
【Abstract】ObjectiveTo review the relationship between T helper cell 1/T helper cell 2 （Th1/Th2） shift and tumor recurrence. MethodsLiteratures on Th1/Th2 shift and tumor recurrence were collected and reviewed. ResultsTh1/Th2 shift can be detected in the host after therapy of the tumor. Tumor cells escape from host immune surveillance by altering Th1/Th2, which could lead to tumor recurrence. ConclusionTh1/Th2 shift is related to tumor recurrence after therapy. Impelling the reverse of Th2 to Th1 and renewing the balance of T helper cells come out to be a new way for tumor therapy.
ObjectiveTo explore the level of hope of patients with tumor recurrence and its affecting factors. MethodsPatients with tumor recurrence admitted in West China Hospital from March 2014 to March 2015 were included in this study. Questionnaire survey was conducted to collect the general information of the patients and the information on their coping style, level of hope and social support. The structural equation model was used to analyze the factors that affect the level of hope in patients with tumor recurrence. ResultsA total of 431 patients were included. The average score of hope in patients with tumor recurrence was 32.88±5.83. Among these patients, 27 (6.26%) had low level of hope, 277 (64.27%) had medium level of hope and 127 (29.47%) had high level of hope. The result of univariate analysis showed that, the level of hope in different genders, marital status, education levels, income levels and types of tumors had significant differences (all P values＜0.05). The result of structural equation model showed that gender (r=-0.322, P<0.001), marital status (r=-0.243, P<0.001), education level (r=-0.219, P<0.001), income (r=0.116, P=0.021) and coping style (r=0.182, P=0.029) had direct effect on the level of hope in patients with tumor recurrence. Social support (r=0.255, P=0.027) and income (r=0.224, P=0.019) could indirectly affect patients’ coping style and therefore the level of hope. ConclusionMost patients with tumor recurrence have medium to high level of hope. Gender, marital status, education level, income and coping style have influence on the level of hope. More attention should be given to patients with low level of hope, and measures should be taken to improve the level of hope basing on the individual situations of patients with tumor recurrence.
ObjectiveTo explore the correlation between the level of hope and coping style in patients with tumor recurrence. MethodsPatients with tumor recurrence admitted to West China Hospital between March 2014 and March 2015 were enrolled as the research subjects. Questionnaire survey was used to collect general information of patients and their level of hope and coping style. ResultsFour hundred and thirty-one patients were enrolled in the study. The score of hope in patients with tumor recurrence was 32.88±5.83. Out of 431 patients, 27 (6.26%) had low level of hope, 277 (64.27%) medium level of hope and 127 (29.47%) high level of hope. Multivariate analysis showed that the coping styles and income could enhance the level of hope, whereas being female, poor marital status, low educational level and long term of complete remission could suppress the level of hope in patients with tumor recurrence. Various coping styles were adopted by patients to cope with the tumor recurrence. Amongst all coping styles, optimism was adopted most frequently by patients, which had the highest score 2.94±0.44. The other coping styles adopted by patients ranked from high to low were conservation 2.88±0.53, self-reliance 2.75±0.56, confrontation 2.73±0.55, fatalism 2.45±0.66, support 2.41±0.52, escape 2.15±0.42 and emotion 2.12±0.59, respectively. The level of hope had a positive correlation with the overall score of coping styles (r=0.112), as well as optimism (r=0.170), confrontation (r=0.166) and self-reliance (r=0.210) (P < 0.05). However, the study showed that the level of hope had no correlation with emotion, escape, conservation, support and fatalism. ConclusionsMost of the patients with tumor recurrence have medium and high level of hope. The coping styles of optimism, confrontation and self-reliance can enhance the level of hope in patients with tumor recurrence. Patients should be encouraged and guided by medical staff to adopt the above-mentioned coping styles to enhance the level of hope, through which to improve the quality of life of the patients with tumor recurrence.
ObjectiveTo summarize the research progress of risk factors related to early recurrence and late recurrence of hepatocellular carcinoma (HCC) after radical resection.MethodsReviewed and summarized recent literatures on factors related to early and late recurrence of HCC after radical resection.ResultsRadical resection was the most effective treatment for HCC, but the postoperative recurrence rate was high, which seriously affected the treatment effect. Current research divided the recurrence after radical resection of HCC into early recurrence (≤2 years) and late recurrence (>2 years). Early recurrence was considered to be mainly caused by intrahepatic metastasis (IM), which was related to the tumor itself, while late recurrence was mainly caused by multicentric occurrence (MO) and was related to background liver factors. Factors of the tumor itself, including tumor diameter and number, invasion of tumor large vessels and microvessels, anatomical and non-anatomical resection, tumor margin, residual liver ischemia (RLI), intermittent total entry hepatic blood flow interruption method (IPM), the expression level of circulating microRNA in serum and long-chain non-coding RNA, circulating tumor cells, and circulating tumor DNA were related to early recurrence; background liver factors, including liver cirrhosis, high viral load, and liver inflammatory activity, were associated with late recurrence.ConclusionsBoth the tumor factors associated with early recurrence and the background liver factors associated with late recurrence can affect the recurrence after radical resection of HCC.